Bailey T C, Trulock E P, Ettinger N A, Storch G A, Cooper J D, Powderly W G
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110.
J Infect Dis. 1992 Mar;165(3):548-52. doi: 10.1093/infdis/165.3.548.
In an effort to prevent cytomegalovirus (CMV) pneumonitis, seven consecutive CMV-seronegative lung transplant recipients of organs from seropositive donors (D+/R-) were given ganciclovir, 2.5-5 mg/kg intravenously twice daily for the first 10-21 days after transplantation, and commercial polyvalent immune globulin, 200-400 mg/kg every 7-14 days intravenously, for the first 2-3 weeks after transplantation. This regimen was followed by oral acyclovir. Six patients developed CMV viremia and all developed CMV pneumonitis. Viremia occurred later in these patients compared with D+/R- patients who received alternative forms of CMV prophylaxis or CMV-seropositive recipients who received no specific prophylaxis (P = .023 and P = .021, respectively). There was no statistical difference in incidence or time to onset of CMV pneumonitis. When given as described, prophylactic ganciclovir and immune globulin followed by oral acyclovir may have delayed CMV viremia but did not prevent it or pneumonitis in high-risk lung transplant recipients.
为预防巨细胞病毒（CMV）肺炎，对7例连续接受来自血清学阳性供体器官的CMV血清学阴性肺移植受者（D+/R-），在移植后的前10 - 21天给予更昔洛韦，静脉注射2.5 - 5mg/kg，每日2次，在移植后的前2 - 3周给予市售多价免疫球蛋白，静脉注射200 - 400mg/kg，每7 - 14天1次。该方案之后给予口服阿昔洛韦。6例患者发生CMV病毒血症，且均发生CMV肺炎。与接受其他形式CMV预防的D+/R-患者或未接受特异性预防的CMV血清学阳性受者相比，这些患者的病毒血症出现得更晚（分别为P = 0.023和P = 0.021）。CMV肺炎的发生率或发病时间无统计学差异。按所述给予预防性更昔洛韦和免疫球蛋白，随后口服阿昔洛韦，可能延迟了CMV病毒血症，但未能预防高危肺移植受者发生病毒血症或肺炎。
